| NPI | 1952946519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 832488) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95013196) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 247004) | |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2022-01-10 |